Corns
Dancers are particularly susceptible to painful corns. Inherent in dance is a battle between a fixed surface (the floor) and the foot delivering force with each step. Each step results in friction that can possibly irritate the ball of the foot and the toes. An irritation of the toes that results in callus is called a corn. Let's take a closer look at corns and how to treat them.
Corns come in all shapes, sizes and varieties. Corns can be found on the tops of toes, between toes, at the tips of toes or even adjacent to the nail. A corn is simply the formation of a callus on a toe. The terms corn and callus can be used interchangeably, but for sake of conversation, a callus is a build up of skin on the bottom of the foot, while a corn is a build up of callus on the toes. Initially, the formation of callus can be a helpful process. As the skin senses a mechanical irritation it responds by thickening, forming a callus. What do we mean by mechanical irritation? Well that could be a shoe that is too tight, it could be friction against the ground or it could even be the mechanical friction that occurs between two toes. In each case, corns form by the recurrent rub of mechanical friction.
The most common corn is due to contraction of the toe placing pressure on the top of the toe. This type of corn, is referred to as a helloma dura (HD), or hard corn, and is often seen in cases of hammer toes where the toe is contracted and pushing against the roof of the shoe. Soft corns, on the other hand, are found between the toes. Soft corns, also known as HM's (helloma molle) or kissing corns, are commonly misdiagnosed as a chronic athlete's foot infection. Soft corns are particularly common in dance. We see a number of professional ballet dancers with chronic soft corns. The culprit in this case is both the position of the foot during point and the design of ballet shoes. With soft corns, we'll see a breakdown of the skin between the toes. This breakdown is usually between the 4th and 5th toes.
Treatment of corns
The most important aspect of treating a corn is to be sure that the shoe is properly fit. Consider the formation of a hard corn to be no more complicated than the analogy of a square peg and a round hole. The foot is the square peg that just doesn't fit into the round hole (the shoe). Our choices are to make the round hole (shoe) bigger or softer by wearing a wider or softer shoe. Or we make the foot (square peg) more narrow by surgically correcting the foot. Alternatively a corn pad can also be used to cushion the corn. Common sense would tell us to first try to modify the shoe or use a corn pad.
The distal end of the shoe that covers the toes is called the toe box. The width and depth of the toe box are very important when trying to obtain a good fit. An improperly fit toe box can contribute to developing corns. Try this simple test. Stand barefoot on the floor. Place your shoe on the floor right next to your foot. Now compare the shape of your forefoot and the shape of the toe box. If the two are incompatible, you're looking for trouble and asking for a corn.
Corn pads come in all kinds of shapes and sizes. Choosing the correct pad depends upon three things; (1) the location of the corn (2) the type of shoe in which you intend to wear the pad and (3) the activity you plan to participate in while wearing the pad. Soft corns respond to the use of a pad that separates the toes. These pads can be made from silicone gel, soft foam or lambs wool. Many folks find relief with a simple cotton ball that'll separate the toes. Foam and gel toes sleeves are another popular solution for hard corns. Hard corns can also be treated with gel cushions and adhesive backed felt 'cut out' pads.
Periodic paring (debridement) of a hard corn can help to reduce the thickness of the callus. This can be accomplished with a safety razor or pumice stone. I'm not a big believer in using topical callus medications to remove corns. These medications are salicylic acid compounds that chemically debride the callus. I see a number of patients each year with burns from using callus medications. The problem with the medication is that it has no 'off' switch. The medication will just keep burning until you have an ulceration and possible infection of the skin.
Permanent correction of corns can be accomplished by a number of different surgical procedures. The procedures vary dramatically based upon the type and location of the corn. Some corns are quite easy to correct, others a bit more difficult. Your podiatrist can help you determine whether you may be a candidate for surgical correction of your corn.
Dancers will always struggle with corns. Well fitted shoes, a dose of prevention and a knowledge of treating corns can make a world of difference in your comfort and performance on the dance floor.
Dr. Oster is a board certified podiatrist and pedorthist. Dr. Oster practices in Granville, Ohio and is medical director of Myfootshop.com, an on-line resource for foot care information and products.